Provider Demographics
NPI:1346676699
Name:UNIVERSITY OF ARKANSAS LITTLE ROCK
Entity type:Organization
Organization Name:UNIVERSITY OF ARKANSAS LITTLE ROCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-569-3188
Mailing Address - Street 1:2801 SOUTH UNIVERSITY AVENUE
Mailing Address - Street 2:UALR HEALTH SERVICES
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1000
Mailing Address - Country:US
Mailing Address - Phone:501-569-3188
Mailing Address - Fax:501-683-7654
Practice Address - Street 1:2801 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1000
Practice Address - Country:US
Practice Address - Phone:501-569-3188
Practice Address - Fax:501-683-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health